Le contexte:entre la gestion de l’aide et les

politiques nationales

Séminaire sur les Politiques Pharmaceutiques à l'attention des experts francophones,

Dr Denis Porignon, HQ/HIS/HGF/HGSOMS Genève, Avril 2014

Stratégies, Plans, Politiques?

• En principe tous les gouvernements tentent de répondre: – Aux problèmes de santé de la population– Aux problèmes de leur système des santé– Aux défis politiques et de développement

Des motivations diverses

· Dissatisfaction with fragmentation· Dissatisfaction with inequalities and

progress· Backlash against withdrawal of the

State

· Failure to reach the MDGs· Limitations of “CE interventions”· Recognition of HS bottlenecks and

of adverse effects of global fragmentation

At country level At global level

Recognition of importance of clarity on “broad policy directions (UC, PHC, HiAP, …)

Country interest in national policy dialogue on health (cfr elections, media,

lobbies)

Global interest in “one plan, one funding mechanism, one M&E framework)

E.g. China, USA, Switzerland, Thailand... E.g. IHP+, Common funding platform...

AIDE AU DÉVELOPPEMENT: LA COMMUNAUTÉ INTERNATIONALE COMPLIQUE LES CHOSES

NEW HEALTH INITIATIVES SINCE 2000...

ECC

MOH(15 Staff)

Damian Foundation

Memisa

Cordaid

Oxfam GB

Cemubac

ONG nationales et internationales

ONG (urgences humanitaires)

Agences multilatérales

MSF Belgium

BASICS

Caritas

CRS

Louvain development

Agences bilatérales/PTF

FometroWorldVision

BDOM

Salvation army

Asrames

Banque mondiale

Plus de 200 partenaires santé

Entités étatiques

Fonds Social de la République

BCECO

13 Directions au niveau du

Min. de la Santé

53 Programmesspécialisés

11 EC Provinciales

11 Ministres Provinciaux de la Santé

Ministère des Finances

Ministère de L'Education

Facultés of Medicine

Ecoles de Santé Publique

Novib

Merlin

Sanru

Gavi

ECHO

UNFPA

ONUSIDA

UNICEFUEUNHCR

OMS

FMI

Fonds mondial

PAM

13 Donor Government program coordination committees

Apefe

PSF-CI

GTZ

SIDA

ACDIBTC CTB

USAID

DFID

BAD

VVOB

[Source: Porignon, WHO, 2008]

IHP+

Fragmentation

Synchroniser (country planning cycle database)

1.1 Family Health Services 1.2 HIV 1.2 malaria1.2 others 1.3 hygiene and environment 1.4 curative1.service delivery and quality of care 2.physical access, transportation 3.human resources development4.strengthening pharmaceuticals sector 5.IEC BCC 6.HMIS/management7. Health care financing 8.crosscutting

HIV

HIV

MCH

Malaria

MCH

Health System

Sour

ces

: For

bila

tera

l and

mul

tilat

eral

don

ors:

don

or m

appi

ng e

xerc

ise

(Janu

ary

2006

); G

loba

l Fun

d fr

om H

APCO

/GFA

TM te

am a

nd M

OH

(in

dise

ase

prev

entio

n an

d co

ntro

l dep

artm

ent)

; PEP

FAR

from

USA

ID [

from

the

Gav

i HSS

pro

posa

l, Et

hiop

ia, 2

007

]

Pas seulement des coûts de transaction:

• Des problèmes de santé oubliés• Des attentes négligées• Les effets de mode• La fragmentation et la segmentation du

marché-santé - la commercialisation sauvage

2000 2001 2002 2003 2004 2005 2006 2007 2008 20090

1

2

3

4

5

6

7

8

9

MDG6Other ODA for Health

Aide officielle - $ par habitant - AFRO

Distortion des priorités

Commercialisation et fragmentation

PTME

PTME

PTME

PTME

PTMEPRESERVATIFS

PRESERVATIFS

PRESERVATIFS

PEC IST

PEC IST

PEC IST

PEC IST

CDV

CDV

CDV

CDV

CDV

CDVIEC

IEC

IEC

IEC

Sécutrans

Sécutrans

Sécutrans

Sécutrans

Sécutrans

Sécutrans

labo VIH

labo VIH

labo VIH

labo VIH

labo VIH

PEC IO

PEC IO

PEC IO

PEC IO

PEC IO

TARV

TARV

TARV

TARV

TARV Coinfection VIH/ Tb

Coinfection VIH/ Tb

Coinfection VIH/ Tb

APS APS

APS

APS

S/E

S/E

S/E S/E

S/E

LE MONDE CHANGE : UN PARTENARIAT INTERNATIONAL

• 2000: GAVI, Gates

• 2002: Global Fund

• 2003: PEPFAR

• 2004: High level Forum

• 2005: Paris: Appropriation, Alignement, Harmonisation, Résultats, “Redevabilité réciproque”

• 2006: GAVI-HSS: alignementUNITAID

• 2007: IHP+

• 2008: Rapport mondial SSP Accra ; Commission FinancementJANS: Politiques, stratégies, plans

• 2009 résolution SSPPlatteforme: harmonisationNew Delhi

• 2010: Planning cycle databaseFeb-May: ADG-GPG-GPGRapport Mondial CUJuin: GLPAutomne: comités régionauxDécembre: IHP+ Bruxelles: le ton

change

• 2011: Platteforme sous IHP+ Résolutions CU et Dialogue politiqueProgramme d’appui UE

• 2012: Réforme OMS

IHP+ today

2007 2014Developing countries: 8 34

Bilateral donors: 8 14

Int'l agencies and foundations*: 11 13

TOTAL 27 61

*African Development Bank, Bill and Melinda Gates Foundation, European Commission, GAVI Alliance, Global Fund, International Labour Organization, UNAIDS, UNICEF, UNDP, USAID, WHO, UNFPA, World Bank

Civil Society Organizations

Les partenaires

Current partners are:

Developing country governmentsAfrica: Benin, Burkina Faso, Burundi, Cameroon, Cap Verde; Chad, Cote d'Ivoire; Democratic Republic of Congo, Djibouti, Gambia, Guinée, Ethiopia, Kenya, Madagascar, Mali, Mauritania, Mozambique, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Sudan, Togo, Uganda, Zambia; Americas: El Salvador; Asia: Cambodia, Nepal, Pakistan, Vietnam

Developed country governmentsAustralia, Belgium, Canada, Finland, France, Germany, Italy, Netherlands, Norway, Portugal, Spain, Sweden, United Kingdom

International agencies, foundations African Development Bank, Bill and Melinda Gates Foundation, European Commission, GAVI Alliance, Global Fund, International Labor Organization, UNAIDS, UNDP, UNFPA, UNICEF, WHO, World Bank

Civil Society at all levelsThe following have sent letters of support to the Partnership: Government of United States of America and OECD/Development Assistance Committee

Il suffit de signer le 'Global Compact' pour adhérer à IHP+

Comment est-ce que cela fonctionne?

•Ce qu’on veut obtenir

•Approches

Plus d’appropriation

Plus d’alignement et d’harmonisation

Focalisation sur les résultats

Plus de redevabilité réciproque

Des processus de planification plus inclusifs, systématiques et avec des bases factuelles

Plus de confiance grâce au JANS; Un appui plus unifié – compacts-pays

Une plateforme de monitoring unifiée pour suivre la mise en oeuvre

Monitoring du comportement

El Salv

ador

Vietnam

Camero

on

Sudan

(not in

c. South Su

dan)

Pakista

nNige

ria

Maurita

nia

Côte d'Iv

oire

Guinea

Senega

l

Djibouti

Nepal

Chad

Cambodia

Togo

Madaga

scar

Cape V

erde

Sierra

Leone

Mali

Uganda

Zambia

Niger

Haiti

DR of Congo

Benin

Kenya

Burkina F

aso

Ethiopia

Guinea Biss

au

Rwanda

Burundi

Gambia

Mozambique

0

10

20

30

40

50

60

70

80

IHP+ Country

Exte

rnal

reso

urce

s as a

% T

HE, 2

011

Source: WHO Global Health Expenditure Database, 2011* External resources: funds or services in kind that are provided by entities not part of the country in question.

Priorities: countries have an increasingly prominent say!

In 2011, only half of IHP+ signatories still received more than 20% of their total health expenditure from external resources*

Est-ce que cela fonctionne?

Toutes ces informations sont accessibles directement sur :www.internationalhealthpartnership.net

!

L’OMS : UN APPUI AUX PROCESSUS DE POLITIQUES ET PLANIFICATIONS NATIONALES

Où faut-il travailler?

Bring togetherHelp

negotiate

Improve Plans / Policies / Strategies

Help translate in operational

plansTest and

learn

Grassroots StratosphereCountry

Bottom-up participatory planning cycle

CSO

CSO

CSONGO

NGO

GHI partners

5 year plan

Annual Review

Annual Review

Annual Review

Annual Review

Political priorities

partners

Lobbies

Elections

Programmes

Private sector 5 year plan

Government plan

Operational plan disease x

Civil service reform

Idealised planning processes

Real-life planning processes

National Health Strategic Plan(measures and instruments for implementation,

operational implications and budget)

Dis

ease

spe

cific

nat

st

rate

gy /

plan

National Health Policy(vision statement and policy directions)

Nat

iona

l Ess

entia

l D

rugs

Pol

icy

Dis

ease

sp

ecifi

c na

t st

rate

gy /

plan

HR

H

Pla

n

Dis

ease

spe

cific

nat

st

rate

gy /

plan

Medium term plan & expenditure framework

District Operati

onal Plan

Medium term plan & expenditure framework

Medium term plan & expenditure framework

District Operati

onal Plan

District Operati

onal Plan

YEARS

Oth

ers

C’est compliqué: des processus, des parapluis et beaucoup de confusion terminologique

Conceptual framework – to build institutions between building blocks and goals

Six building blocks four PHC reforms Goal indicators

HRH: ressources humaines I&E: Infrastructure and équipementsL&M: Logistique et médicaments

HIS: syst. d'information sanitaire L&G: Leadership and gouvernanceHFA: activités de financement

Revue de 25 plans sanitaires nationaux

)25 pays à FR(Un pays…

Ce que l’OMS devrait faire• Au niveau pays:

– Des plans meilleurs: globaux, équilibrés, mis-en-oeuvre, synchronisés, appropriés

– Des processus meilleurs: inclusifs, orientés vers des résultats

– Des services intégrés: SSP, CU, HinAP

• A l’interface :– Renforcer la capacité de négociation

• Au niveau global:– l’effectivité de l’aide et ses

conséquences– L’importance de la santé dans

l’après OMD

situation analysis, align

programme plans and national

plans, include stakeholders

Provide balanced inputs to

support health systems

Financing

Medicines

Technology & Infrastructure

Workforce

Critical subsystems

Including MDG 8

Health Systems Building Blocks

Policy Directionsuniversal coverage ,

primary care , health in all policies

Strategies Plans Regulation

Inclusive policy dialogue

Strategic informationResearch

Governance

Mobilize and channel aid

Provide guidance on Cost effective interventions

Adapt service delivery

models (integration, people-centeredness,

chronic care, access,…)

Comprehensive, integrated, continuous and people-

centred care along the life-cycle

Cost-effective and safe interventions: clinical &

public health

Universal access to close-to-client

networks, responsible for a defined population

Including interventions for MDGs 4, 5, 6

Service Delivery

Trust in fairness, protection, compe-

tence, accountability

Health Equity

Health & health security

Social inclusion and participation

Incl. MDGs 1-3-4 -5-6

Including MDGs 4-5-6

Impact

Including MDG 3

Mainly at sub national level

Funding support to programmes

Country leadership,values, capacities

Value given to health, equity, solidarity, social justice

Individual & institutional capacities

Effective aidCountry ownershipAlignmentHarmonizationResultsMutual accountability

Political commitment

Political commitment

Mainly at national or supra national level

Au sein de l’OMS

• Le modèle Global Health Initiatives-HSS• Secrétariat IHP+• GLP• Appui au dialogue politique UE - Luxembourg• Vers un plus grande priorité organisationelle

1 2 3 4 5

Il faut prévoir,garder la vue d’ensemble du secteur

planifier comme s’il n’y avait pas de bailleurs